Individual
GLEN FITZGERALD MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3625 UNIVERSITY BLVD S, JACKSONVILLE, FL 32216-4207
(904) 421-2119
Mailing address
851 TRAFALGAR COURT, SUITE 200E, MAITLAND, FL 32751
(407) 667-0444
(407) 667-4338
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME 76157
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
254973500
—
FL
Enumeration date
08/19/2005
Last updated
07/14/2017
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